CAJ | 학술논문

目的研究高龄患者胃癌根治术后并发症的特点和影响因素，为降低患者并发症的发生率，提高手术疗效提供依据。方法选取于2011年7月至2013年7月于我区医院进行胃癌根治术治疗的高龄患者48例，并分析其术后并发症产生、发展的临床特点，并通过单因素、 Logistic多因素回归分析，寻找危险因素。结果48例患者中，共有12例出现术后并发症，其中2例同时发生两种并发症。即包括腹腔感染2例，心功能不全1例，肠梗阻3例，胰瘘1例、吻合口瘘1例，切口裂开1例、肺部感染2例。3例患者发生了心肺功能衰竭导致的死亡。将术后产生并发症的老年患者归纳入并发症组(n=12)，无并发症的患者归纳入无并发症组(n=36)，比较发现，患者手术时间、手术方式、术前白蛋白、术前合并症、肿瘤直径、联合脏器切除、输血>850 mL与患者在术后的严重并发症密切相关( P<0.05)。经研究分析发现，白蛋白水平可以降低患者术后严重并发症的发生率。术前合并症，输血>850 mL、胸腹联合手术，联合脏器切除等都是术后严重并发症的危险诱因。结论要降低高龄胃癌患者术后并发症的产生，应该制定个体化的治疗方案，在确保根治术顺利进行的前提下，尽量避免大量输血和联合脏器切除从而降低严重并发症发生的危险。
목적연구고령환자위암근치술후병발증적특점화영향인소，위강저환자병발증적발생솔，제고수술료효제공의거。방법선취우2011년7월지2013년7월우아구의원진행위암근치술치료적고령환자48례，병분석기술후병발증산생、발전적림상특점，병통과단인소、 Logistic다인소회귀분석，심조위험인소。결과48례환자중，공유12례출현술후병발증，기중2례동시발생량충병발증。즉포괄복강감염2례，심공능불전1례，장경조3례，이루1례、문합구루1례，절구렬개1례、폐부감염2례。3례환자발생료심폐공능쇠갈도치적사망。장술후산생병발증적노년환자귀납입병발증조(n=12)，무병발증적환자귀납입무병발증조(n=36)，비교발현，환자수술시간、수술방식、술전백단백、술전합병증、종류직경、연합장기절제、수혈>850 mL여환자재술후적엄중병발증밀절상관( P<0.05)。경연구분석발현，백단백수평가이강저환자술후엄중병발증적발생솔。술전합병증，수혈>850 mL、흉복연합수술，연합장기절제등도시술후엄중병발증적위험유인。결론요강저고령위암환자술후병발증적산생，응해제정개체화적치료방안，재학보근치술순리진행적전제하，진량피면대량수혈화연합장기절제종이강저엄중병발증발생적위험。
Objective To study the characteristics and the influence factors of elderly patients with serious complications after radical operation of gastric cancer, so as to reduce the incidence of complications in patients, and to provide information for improving the operation effect. Methods 48 cases of elderly patients with gastric cancer treated with radical operation were selected in our hospi-tal from July 2011 to July 2013. The clinical characteristics of the occurrence and development of their postoperative complications were analyzed. Risk factors were explored by univariate analysis and logistic regression analysis. Results Of the 48 patients, a total of 12 cases had postoperative complications, including 2 cases with two complications. The 12 cases included 2 cases of peritoneal infection, 1 case of cardiac insufficiency, 3 cases of intestinal obstruction, 1 case of pancreatic fistula, 1 case of anastomotic fistula, 1 case of in-cision dehiscence, 2 cases of pulmonary infection and 3 cases with heart and lung failure leading to death. Elderly patients with postop-erative complication were classified as complication group ( n=12 ) , while those without postoperative complication were classified as complication-free group (n=36). In comparison, operation time, operation mode, preoperative albumin, preoperative complications, tumor diameter, combined organ resection and blood transfusion (>850 mL) were closely related with serious postoperative complica-tions (P<0.05). It was found that albumin levels can reduce the incidence rate of postoperative complications. Preoperative complica-tions, blood transfusion (>850 mL), combined thoraco abdominal operation and combined organ resection were the risk factors of seri-ous postoperative complications. Conclusion Individualized treatment should be conducted in order to reduce the incidence of postop-erative complications in elderly patients with gastric cancer. In the precondition of smooth radical operation, massive blood transfusion and combined organ resection should be avoided, so as to reduce the risk of serious postoperative complications.